It’s unreasonable to expect “cures” for most diseases

I often encounter Facebook memes denouncing pharmaceutical companies with words to the effect of: “Big Pharma isn’t interested in making cures, they’re interested in making customers,” as if this were some deep insight into a grave moral failing on the part of the entire industry.  Now, I’m quite sure that there are perverse incentives and inappropriate goals scattered throughout the medical industry in general, from the level of the individual physician, to pharmaceutical manufacturers, to the insurance industry, and everywhere else in the healthcare field.  There’s little doubt that these injustices and inefficiencies gum up the works for everyone, making healthcare overall worse than it might otherwise be.  But simply to complain about the fact that most medications don’t “cure” our many modern ailments is to confess a misunderstanding of the nature of biology and medical treatment.

At least some of this confusion is understandable, because we’ve all been spoiled by the success of antibiotics.  Apart from the very old pain medicines—such as opium and its derivatives, and to a lesser degree marijuana—perhaps the first real, modern examples of “medicine” were the antibiotics.  When they work as intended, they “cure” the diseases at which they are targeted.  This is because those diseases involve the literal invasion of the human body by other organisms, different enough from us to be responsive to classes of compounds that attack their biology but not ours.  It’s good that this was the first big medication success, because these diseases have been responsible for the lion’s share of premature death throughout human existence.  When a person takes antibiotics for a straightforward pneumonia, or an ordinary skin infection, or for strep throat, or some other bacterial infection, the person really can be cured.

Unfortunately, our tenuous conquest of much infectious disease—and the roughly contemporaneous improvements in our protection from bacteria brought about by public sanitation and cleanliness standards in the medical professions and the food industry—has allowed us to live long enough to become ever more subject to ailments that are much more difficult to conquer.  These ailments are manifestations of the second law of thermodynamics acting on bodies that are, at bottom, Rube Goldberg style machines, hacked and cobbled together from spare parts (as it were) by nature over the eons—machines now living in a world that is quite different from the one in which the many thousands of generations of our ancestors evolved.

There’s no simple “cure” for the “disease” of hypertension, for instance, because hypertension is not caused by external entities attacking on our bodies, but rather by a dysfunction of the machinery, a subtle lack of balance or alignment, perhaps the product of wear and tear of the type that tends to accumulate and worsen over time in any complex machine.

Evolution does its work on human bodies at the level of reproductive success.  When we’ve reached an age that our ancestors were far from likely to reach, let alone at which they were likely to reproduce, then evolution isn’t going to weed out or fine-tune our functions to last singificantly longer.  There’s nothing pushing it in that direction.

Problems like high blood pressure, high cholesterol, heart disease, cataracts, arthritis, dementia, and the like, exist at a fundamental level in the design of our bodies.  To “cure” them would involve a thorough redesign of the entire structure, top to bottom, cell by cell, gene by gene.  While such a cure is possible in principle, it is far beyond our current level of understanding regarding this most complicated structure in the known universe:  us.

Unfortunately, we humans tend to become spoiled very quickly and easily.  We decry the fact, for instance, that to treat high cholesterol that’s unresponsive to lifestyle changes, we must take medications, and that we must stay on those medications indefinitely, and that those medications have side-effects.  It’s not completely unreasonable to lament this fact, and even to feel a little sorry for ourselves.  The universe can be a cold, hard place, and it doesn’t cut us any special slack, much though we might wish that it would.  But to claim that the pharmaceutical companies, working to treat problems that we want to correct so that we can live longer, healthier lives, are deliberately not finding cures for such things just because they want to keep us paying them, is to confess a misunderstanding of our general situation.

Again, this is not to say that there isn’t corruption and greed within the industry, as there is in any industry, and that it shouldn’t be dealt with when it happens.  But to complain about the fact that “Big Pharma” makes products that you need to keep using indefinitely to keep getting results—and to bemoan the side-effects as though they were the products of carelessness or recklessness, or even deliberate acts of evil, rather than inescapable outcomes of any fiddling with a system as complex as the human body—is ridiculous.  It’s about as sensible as complaining that the food industry doesn’t make food that you only have to eat once, and then you will never need to eat anything again—some mystical “cure” for hunger.

And don’t even get me started about people who complain about the lack of “a cure” for cancer, or who entertain the notion that such a cure already exists but is being withheld by some evil conspiracy somewhere.  To expect that there might be a single “cure” for all cancers, or even for one entire class of cancers, is to confess an almost complete lack of knowledge about what cancer is.  There is only one thing that halts all cancers—and coincidentally, it stops all other ailments as well, including high blood pressure, diabetes, heart disease, arthritis, and even erectile dysfunction:  the death of the person who has the disease.

But I don’t think most people would consider that a cure.

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